Alcohol is an addictive drug and although many people drink safely, you can become psychologically and physically dependent on it. In the UK, around nine in 100 men and four in 100 women show signs of being dependent on alcohol.
Alcohol dependence – or 'alcohol dependence syndrome' (formerly known as alcoholism) – is a pattern of routinely drinking excessive amounts of alcohol over a long period of time, and giving priority to drinking over other activities and obligations in your life. It can cause or worsen psychological and physical health problems and can seriously affect your relationships with family and friends. It can also affect your job, or result in drinking-related offences.
The main symptom of alcohol dependence is having an overpowering urge to drink alcohol and not being able to limit or stop drinking once you have started. Some people who are dependent on alcohol report being preoccupied with it and that the need to drink alcohol takes over their lives.
If you drink regularly, your body gets used to lots of alcohol and you may find that you need to drink increasingly more to feel its effects. This is known as alcohol tolerance and has a role in you becoming addicted to alcohol.
Other symptoms of alcohol dependence can include:
You don’t necessarily need to have all of these symptoms to be affected by alcohol dependence, and any of the above can indicate that there is a problem.
Another sign that you're dependent on alcohol is if you have physical withdrawal symptoms when you stop drinking. You may feel the need to drink to avoid or relieve such symptoms. Withdrawal symptoms include:
If you drink large amounts of alcohol, you’re at greater risk of having:
Another potential complication is delirium tremens, which can happen if you stop drinking immediately rather than cutting down gradually. This causes symptoms such as shaking, sweating, diarrhoea and seizures. It may also cause anxiety, confusion, paranoia and hallucinations (where you see and/or hear things that aren't there). Delirium tremens requires urgent medical attention as it can be life threatening.
If you’re pregnant and drink alcohol, it can affect the development of your unborn baby and may cause him or her to have a condition called foetal alcohol syndrome. Drinking during pregnancy can also increase your chance of having a miscarriage.
There isn’t one main cause of alcohol dependence. People drink alcohol for many different reasons. You may, for example, use alcohol as a way of dealing with anxiety and depression. However, although it may help you dismiss your problems in the short term, alcohol actually makes anxiety and depression worse because it interacts with chemicals called neurotransmitters in your brain that alter your mood.
Social factors, such as the affordability and availability of alcohol, peer pressure and the buying of rounds in groups may have a role in causing alcohol dependency.
Alcohol dependence can run in families – if one of your parents is dependent on alcohol, you’re four times more likely to develop it too.
Acknowledging that alcohol has a negative impact on your life is an important first step to get the help and support that is available. If you feel that you may be dependent on alcohol, see your GP. He or she will ask about your symptoms and may examine you. Your GP may also ask you about your medical history.
Your GP will ask about your drinking, how you feel about it and its effect on your life and wellbeing. He or she may ask you some specific questions that are listed in questionnaires, which aim to establish if you’re alcohol dependent. Examples of these questionnaires include the alcohol use disorders identification test (AUDIT) and severity of alcohol dependence questionnaire (SADQ).
If your lifestyle, psychological or physical illness or the score on one of the questionnaires indicate you may be drinking too much, your GP may refer you to specialist alcohol services. In most areas in the UK, you can self-refer to some alcohol services too. If your problem is less severe, your GP may give you advice or offer written information aimed at preventing you from developing problems in the future.
Your treatment will be tailored to suit you and will depend on how much you drink, and if you have any physical or mental health problems.
Your GP will assess your level of alcohol dependence. If you have severe alcohol dependence, especially if there is evidence of physical damage to your internal organs such as your liver, then your GP is likely to advise you to cut down on alcohol with the aim of stopping drinking completely. This is called abstinence.
However, there are people with a lower level of alcohol use or who may not be willing to give up alcohol completely for whom controlled drinking might be a possibility. It's important to work with your GP to agree on a treatment plan that is realistic for you, and which you can stick to. It may be that you aim to cut down your drinking to a controlled, lower level.
There are professional services and groups that can give you help and support to stop drinking.
Acknowledging that you're dependent on alcohol and finding the determination to change and the willpower to do so is important for your treatment to be a success. There are a number of self-help tools such as information leaflets and websites that can help you to stop drinking. These tools should normally be used in addition to help from a healthcare professional or voluntary agency.
If you're a heavy drinker, you may need to be supervised by health professionals while you give up alcohol (assisted alcohol withdrawal). This is because the physical withdrawal symptoms associated with stopping drinking can carry health risks. Detoxification or ‘detox’ is a planned withdrawal from drinking alcohol and may involve taking a short course of a medicine to help prevent withdrawal symptoms. Benzodiazepine medicines, such as diazepam or chlordiazepoxide, are most commonly used during detoxification. Your GP may prescribe these for you to take at home or you may need to stay in a specialist treatment centre during detoxification. You will gradually take less and less of the medicine until you can stop altogether – medicines are only a short-term treatment to help you gain control and not a long-term solution.
You might find that talking to someone about your drinking problem is a useful and important part of your treatment. You may wish to speak to your GP or trained counsellors who can help you understand the reasons for your drinking, and give you skills to control or stop the urge to drink.
Your partner or family may also be invited to attend counselling with you and be involved in your treatment.
There are a number of support groups in the UK where you can share personal experiences and advice with other people who are dependent on alcohol. Mutual help support groups can help you while you're giving up and can also help prevent you becoming dependent again. Support groups such as Alcoholics Anonymous and Al-Anon (a support group for family and friends of those who are alcohol dependent) are found nationwide.
You may be deficient in vitamins and minerals due to your alcohol intake; vitamin B1 (thiamine) deficiency is common, for example. Your GP may prescribe thiamine tablets and ask you to take multivitamins.
If you successfully give up drinking, starting again (or relapsing) is common. There are a number of ways that you can plan ahead and minimise the risks of this happening to you. It's important to remember that treatment for alcohol dependence is an ongoing process. You're more likely to successfully give up drinking if you receive help and support from family and friends, mutual help support groups, your GP or from a counsellor.
There are medicines that your GP may prescribe that can help prevent your cravings for alcohol (such as acamprosate) or other medicines (such as disulfiram), which help deter you from drinking by giving you unpleasant symptoms such as vomiting and a headache if you drink alcohol.
Produced by Rebecca Canvin, Bupa Health Information Team, June 2012.
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